Unmasking obstructive sleep apnea: Estimated prevalence and impact in the United States

Obstructive sleep apnea (OSA) is a serious chronic disease, characterized by repeated upper airway obstructions during sleep, leading to episodes of disrupted breathing, sleep fragmentation, and reduced oxygen saturation. Adjusting for obesity as a major risk factor, we aimed to provide a contemporary estimate of the OSA prevalence in the United States (US).

A literature-based systematic review was conducted to identify studies of OSA prevalence in adults using the AHI₄ criteria (all apneas plus hypopneas associated with ≥4% oxygen desaturation). OSA was defined as having an AHI₄ ≥ 5 events/hr. For total prevalence, age-, and gender-specific rates were estimated based on eligible studies and the base-year estimation for 2004 was calculated. The obesity population attributable fraction was applied to base-year estimates to project OSA prevalence in year 2024. The AHI₄ distribution of mild (5-<15), moderate (15-<30) and severe (≥30 events/hr) OSA was also estimated.

A total of 83.7 million adults (aged 20 years and older) were estimated to be living with OSA in the US in 2024, of whom 49,459,041 (59%) were males and 34,257,378 (41%) females. This translates to 32.4% overall prevalence in the US among adults aged 20 years and older, with 39.1% among males and 26.0% in females, adjusting for obesity. The distribution of OSA severity was estimated to be 52% mild, 30% moderate, and 18% severe.

Our findings suggest that OSA is highly prevalent among US adults. Despite its substantial prevalence, OSA remains largely undiagnosed, highlighting the urgent need for improved screening and diagnosis.